In this episode, we speak with Dr. Danielle Allen, professor of political philosophy, ethics, and public policy at Harvard and Director of the Allen Lab for Democracy Renovation, about the extent to which we should involve laypeople in decisions about health and science policy through democratic, participatory processes.(00:00) Our introduction(08:47) Interview begins(12:23) Power-sharing in the domains of health and science policy(16:23) Is representative democracy enough?(21:03) Does power-sharing always require democratic mechanisms?(24:13) What role should professional ethicists play in shaping policy?(31:03) Does power-sharing produce other substantive benefits?(32:56) Trade-offs between power-sharing processes and good outcomes(39:38) Is respectful civic engagement a realistic goal in our polarized society?(47:46) The problem of regulatory capture (52:31) Worries about overburdening laypeopleMentioned or Referenced:Danielle Allen, Justice by Means of DemocracyDanielle Allen, Democracy in the Time of CoronavirusThe Ezra Klein Show, Transcript: Ezra Klein Interviews Danielle AllenCommission on the Practice of Democratic Citizenship, Our Common Purpose: Reinventing American Democracy for the 21st CenturyEducating for American Democracy, Roadmap to Educating for American DemocracyMedical University of South Carolina, Community-Engaged ResearchSTAT, Expert panel votes down Biogen’s Alzheimer’s drug, and rebukes the FDA in the process The New York Times, Inside a Campaign to Get Medicare Coverage for a New Alzheimer’s DrugThe New York Times, How an Unproven Alzheimer’s Drug Got ApprovedFierce Pharma, Big Pharma's shelling out big-time to patient organizations. Is there any quid pro quo?The San Francisco Chronicle, 87 permits, 1,000 days of meetings and $500,000 in fees: How bureaucracy fuels S.F.’s housing crisisBio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we speak with Marc Lipsitch, epidemiologist and professor at the Harvard T.H. Chan School of Public Health and Director of the Center for Communicable Disease Dynamics, about what lessons we should take from the COVID-19 pandemic, what role research should play in mitigating and preventing future pandemics, and how we should regulate research on potential pandemic pathogens.(00:00) Our introduction(11:26) Interview begins(12:35) The role of surveillance in preventing pandemics(23:05) What policymakers got wrong during the COVID-19 pandemic and why(26:23) Could we have prevented backlash to COVID-19 mitigation policies?(30:34) How to communicate uncertainty to the public during a pandemic(35:32) What role human challenge trials should play in reducing harm(40:02) How should we mitigate research risks to non-participants?(48:02) How socially valuable is research on potential pandemic pathogens?(53:21) The role of research funders and other non-regulatory bodies (59:34) The role of bioethicistsRelevant readings:The Covid Crisis Group, Lessons From the Covid War: An Investigative ReportThe Guardian, “Factory Farms of Disease: How Industrial Chicken Production is Breeding the Next Pandemic”Our World in Data, Excess mortality during the Coronavirus pandemic (COVID-19)Wikipedia, Black DeathThe Guardian, Factory farms of disease: how industrial chicken production is breeding the next pandemicWorld Health Organization, Human infection with avian influenza A (H5N8) - Russian FederationCDC, Ferrets Friedrich Frischknech, The history of biological warfareKevin Esvelt, Mitigating catastrophic biorisks USA Today, Lab-created bird flu virus accident shows lax oversight of risky 'gain of function' researchWikipedia, 1978 smallpox outbreak in the United Kingdom Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we speak with Dr. Sally Haslanger, Ford Professor of Philosophy and Women’s and Gender Studies at MIT, about what norms are, how we can know when they need to be changed, and how we should change them.(00:00) Our introduction(5:12) Interview begins(16:07) What grounds social norms(18:56) How we can know a moral norm is problematic(23:11) How social and moral norms relate(29:49) What is social critique?(35:54) Social critique without situated knowledge of a social practice(50:06) Are structural solutions always better?(52:21) The role of philanthropy and expertise(1:05:18) What makes some norms coercive(1:07:47) How to change the social world(1:12:46) Who’s responsible for disrupting social norms?(1:15:18) Should bioethicists be activists?Relevant readings:Elizabeth Anderson, “Beyond Homo Economicus: New Developments in Theories of Social Norms”Sally Haslanger, “Political Epistemology and Social Critique”Sally Haslanger, “Methods of Social Critique”Sally Haslanger and Clare Chambers, “Ideology and Critique”Wolfgang Streeck and Kathleen Thelen, Beyond Continuity: Institutional Change in Advanced Political EconomiesBio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we speak with Dr. Jennifer Blumenthal-Barby, a philosopher and bioethicist at Baylor College of Medicine, about why she thinks clinicians are often permitted, and even required, to use insights from behavioral economics and decision psychology to shape patients’ medical decisions.(00:00) Our introduction(05:50) Interview begins(07:57) What is a nudge?(15:15) Is there any such thing as pure rational persuasion?(18:12) What makes a decision good or bad?(23:15) Can nudges make patients’ medical decisions better?(42:40) How credible are the findings of decision science?(45:21) Do nudges disrespect autonomy?(56:16) Justifying nudges as instances of soft paternalism(59:08) Are pro-social medical nudges also justified?(1:01:30) How the doctor-patient relationship affects the ethics of nudging(1:05:51) Is nudging ever wrong?Relevant readings:Jennifer Blumenthal-Barby, Good Ethics and Bad Choices: The Relevance of Behavioral Economics for Medical EthicsJennifer Blumenthal-Barby, “Between Reason and Coercion: Ethically Permissible Influence in Health Care and Health Policy Contexts”Moti Gorin, Steve Joffe, Neal Dickert, and Scott Halpern, “Justifying Clinical Nudges”Robert Noggle, “Pressure, Trickery, and a Unified Account of Manipulation”Sophie Gibert, “The Wrong of Wrongful Manipulation”Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we speak with Dr. Jeff Sebo, a philosopher and bioethicist at New York University, about what it would mean to take seriously the possibility that non-human animals (including insects) and future AI systems might matter morally.(00:00) Our introduction(05:56) Interview begins(07:21) The moral circle vs. the legal and political circles(13:18) Why has the moral circle expanded over time?(20:53) How should we trade off human and non-human welfare in practice?(33:40) How should we treat non-human animals in research?(37:25) How should we treat current AI systems, given that we’re not certain that they’re not sentient?(46:22) Philosophical underpinnings: What grounds moral status?(52:09) Philosophical underpinnings: What is sentience?(56:20) Philosophical underpinnings: Interspecies welfare comparisons(1:00:22) Philosophical underpinnings: Moral uncertainty and humility(1:10:35) What causes should you prioritize if you care about non-human animal welfare?(1:19:09) Is the total welfare in the world net negative; and if so, should this affect which causes we prioritize?Relevant readings:Bob Fischer and Hayley Clatterbuck, “The Risks and Rewards of Prioritizing Animals of Uncertain Sentience”Ben Goldfrab, “Animals need infrastructure, too”Kyle Fish, “Net global welfare may be negative and declining”Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we speak with Dr. Christopher Robichaud, Director of Pedagogical Innovation at Harvard’s Edmond and Lily Safra Center for Ethics, about whether and how we can teach scientists, doctors, and other professionals to be more ethical, what the goals of ethics education ought to be, and how we can know we’re achieving them.(00:00) Our introduction(13:18) Interview begins(17:39) Does ethics education miss the point?(22:05) Four goals of ethics education(30:05) Goals: Improving moral reasoning(32:39) What drives the focus on moral reasoning?(36:05) Does focusing on moral reasoning promote moral relativism or nihilism?(39:24) Goals: Promoting good behavior(41:49) Goals: Cultivating moral perception(47:43) Goals: Helping students live good lives(51:33) Strategies for teaching ethics to practitioners(53:43) The Applied Model for teaching practical ethics(57:29) Measuring the effectiveness of ethics education(1:04:46) Chris’s take on Effective Altruism(1:07:38) Philosophical underpinnings: Williams and MurdochReferenced:Daniel Callahan, “Chapter 2: Goals in the Teaching of Ethics” in Ethics Teaching in Higher EducationLeah Pierson, “Ethics Education in U.S. Medical Schools’ Curricula”Rachel Mintz, Leah Pierson, and David Gibbes Miller, “Rethinking Professionalism Assessments in Medical Education”Leah Pierson, "Ethics Education in U.S. Medical Schools' Curricula"Derek Bok, “Can Ethics Be Taught?”Anthony Burgess, A Clockwork OrangeBio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we speak with Professor Holly Fernandez Lynch, a lawyer and bioethicist in the Department of Medical Ethics and Health Policy at the University of Pennsylvania and founder and co-chair of AEREO, an organization that aims to understand and measure the benefits and drawbacks of the IRB system. With Holly, we discuss what we currently know about the benefits and costs of IRBs, why it’s so hard to measure them, and whether justifying the IRB system requires establishing that it produces good outcomes, or just that it follows good procedures.(00:00) Our introduction(04:58) Interview begins(05:41) Do IRBs protect the rights and welfare of research participants?(11:20) Why not restrict the scope of IRB review to the most risky research?(26:49) Do IRBs promote justice?(33:32) Do IRBs foster a culture of ethical concern?(41:20) Do IRBs maintain and promote trust in the research enterprise?(47:18) Do IRBs promote socially valuable, scientifically valid research?(50:54) Given their costs, financial and otherwise, might IRBs do more harm than good?(1:00:52) Why haven’t we been able to develop clear standards for measuring IRB outcomes?(1:05:42) Should we expect IRBs to offer more than procedural protections?(1:09:27) Developing a system of IRB precedent(1:16:48) Why is it so hard to reform the IRB system?Mentioned:Alex John London, For the Common Good: Philosophical Foundations of Research EthicsJonathan Kimmelman, “Better to be in the Placebo Arm for Trials of Neurological Therapies?”Richard Beigi et al., “The Need for Inclusion of Pregnant Women in COVID-19 Vaccine Trials”Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

Content warning: This episode contains discussions of suicide, suicidal ideation, and symptoms of mental illness. If you or someone you know or love is struggling, please seek help. You can call or text 988 to reach the suicide and crisis lifeline.In this episode, we interview Dr. Marie Nicolini, a psychiatrist and bioethicist who testified to the Canadian Parliament as an expert witness on the issue of medical aid in dying (MAID) for mental disorders. With Marie, we discuss whether we should legalize MAID for mental illness, what practical and conceptual challenges we face in constructing appropriate safeguards, and how legalizing MAID might interact with efforts to prevent suicide and improve psychosocial services for people with mental illness.(00:00) Our introduction(13:02) Interview begins(14:07) Safeguards: The voluntariness requirement(23:16) Safeguards: The unbearable suffering requirement(33:01) Safeguards: The incurability requirement(42:38) Safeguards: Retrospective oversight(46:07) Is MAID for mental illness at odds with suicide prevention?(1:01:08) Does legalizing MAID disincentivize improving psychosocial services(1:06:13) What does MAID express about how we value people’s lives?(1:12:44) The future of MAID policyBio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we interview Dr. Govind Persad, an expert on resource allocation whose work influenced COVID-19 allocation policies, about how we should allocate scarce medical resources, what stood in the way of optimal allocation during the covid pandemic, and how we can improve resource allocation within the US healthcare system. (00:00) Our Introduction(04:05) Interview begins(12:06) What is a “framework” for allocating health resources?(14:20) What normative assumptions are baked into allocation frameworks?(19:36) What principles are included in allocation frameworks?(20:24) Overview of first two principles: Maximizing benefits and favoring the worst off(26:11) Overview of second two principles: Equal treatment and rewarding social usefulness(39:37) Which benefits matter when allocating health resources?(43:33) Should we account for quality of life?(49:22) Should we prioritize the youngest first?(53:29) When does reciprocity matter?(57:32) Putting principles into practice(1:02:22) Legal considerations(1:07:25) Improving resource allocation in the US healthcare system(1:13:16) How living through the pandemic influenced Govind’s researchMentioned:“Principles for Allocation of Scarce Medical Interventions” by Govind Persad, Alan Wertheimer, and Ezekiel Emanuel (2009)“Fair Allocation of Scarce Medical Resources in the Time of COVID-19” by Ezekiel Emanuel et al. (2020)“The Rebugnant Conclusion” by Jeff Sebo (Draft)“Equality and Priority” by Derek Parfit (1997)“Should the Numbers Count?” by John Taurek (1977)“In the Line For Scarce Covid Treatments, Immunocompromised Americans Should Go Before the Unvaccinated” by Govind Persad and Emily Largent (Opinion in The Washington Post, 2022)“How COVID-19 Hollowed Out a Generation of Young Black Men” by Akilah Johnson and Nina Martin (ProPublica, 2020)Thoughts? Guest suggestions? Email us at biounethical@gmail.comYou can find more episodes of Bio(un)ethical at biounethical.com. Sign up for our email list at biounethical.com to receive episode alerts and submit questions for upcoming guests.To support us, please subscribe, rate, and review our show wherever you get your podcasts, and recommend it to a friend. For updates, follow Leah and Sophie on Twitter (leah_pierson and sophiehgibert).Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we interview Dr. Robert Steel about how we should assess the risks and benefits of research, what justifies research oversight, and whether there should be upper limits on the amount of risk research participants are exposed to.(00:00) Our introduction(05:06) Start of interview; IRB background(13:34) The notion of minimal risk(24:49) Justifying IRB risk evaluation: Initial discussion(37:07) Justifying IRB risk evaluation: Group soft paternalism(45:57) Justifying IRB risk evaluation: Maintaining social trust(54:13) IRB assessment of social value(56:25) Alternative justifications (beneficence, non-maleficence, non-exploitation)(01:02:36) Implications: Benefits to society count; No upper limits on risk(01:15:07) Robert’s future work on government policy trialsMentioned:Survey of pediatric IRB chairs: “How do institutional review boards apply the federal risk and benefit standards for pediatric research?” by Shah et al. (2004)Exploitation by Alan Wertheimer (1996)“Facing up to paternalism in research ethics” by Franklin Miller and Alan Wertheimer (2007)Public Trust: “Is there an ethical upper limit on risks to study participants?” by Nir Eyal (2020)“What makes clinical research ethical?” by Ezekiel Emanuel, David Wendler, and Christine Grady (2000)“Reconceptualizing Risk-Benefit Analyses: the Case of HIV Cure Research” by Robert Steel (2020)“A framework for risk-benefit evaluations in biomedical research” by Annette Rid and David Wendler (2011)Thoughts? Guest suggestions? Email us at biounethical@gmail.comYou can find more episodes of Bio(un)ethical at biounethical.com and sign up for our email list to receive episode alerts and submit questions for upcoming guests.To support us, please subscribe, rate, and review our show wherever you get your podcasts, and recommend it to a friend. For updates, follow Leah and Sophie on Twitter (leah_pierson and sophiehgibert).Bio(un)ethical is written and edited by Leah Pierson and Sophie Gibert, with production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

Welcome to Bio(un)ethical, the podcast where we question existing norms in medicine, science, and public health.In this episode, we (Leah Pierson and Sophie Gibert) introduce the podcast and talk about why we started it and what we hope to achieve.If you want to support us, the best way is to subscribe, rate, and review our show wherever you get your podcasts, and recommend it to a friend. You can find more episodes at our website, biounethical.com, and can also join our email list to receive episode alerts and submit questions for upcoming guests. Thoughts? Guest suggestions? Email us at biounethical@gmail.comFor the latest updates, follow us on Twitter (leah_pierson and sophiehgibert)Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.